The Project Proposal of Smoking Cessation among Nurses - Research Paper Example

?Running head: RESEARCH SUPPORT Research Support Smoking is a serious problem among nurses. Therefore, facility-based smoking cessation programs have the potential to reduce the scope of the smoking problem in nursing environments. This paper provides research support to a facility-based smoking cessation programs for nurses. The most important elements of the program and their potential validity are discussed. The paper provides recommendations for program improvement, based on the current research. Keywords: smoking, cessation, nurses. Research Support for the Project Proposal of Smoking Cessation among Nurses Smoking is a serious problem among nurses. Much has been written and said about the role and importance of smoking cessation programs in clinical settings. Smoking causes profound impacts on the quality of nursing care. In some instances, smoking among nurses is justified by the amount of stress they constantly experience in the workplace: Tagliacozzo and Vaughn (1986) established a direct relation between work-related stresses and smoking among nurses. This however does not mean that nurses are secured from the risks and negative consequences of smoking. A facility-based smoking cessation program has the potential to reduce smoking among nurses, through counseling support, monetary incentives, nicotine-replacement therapies, and Cognitive-Behavioral therapy. The role and significance of counseling support in smoking cessation was discussed in abundance. Individual, group, or telephone counseling was extensively used to raise smoking cessation rates in various population groups. Lancaster and Stead (2008) reviewed previous studies and concluded that individual counseling increased the likelihood of smoking cessation. That the rates of cessation varied across population groups was mainly attributed to differences in individual motivation and in how counselors defined the cessation concept (Lancaster & Stead, 2008). It should be noted, that individual counseling can take many forms, from face-to-face repeated contacts to telephone counseling; the latter has proved to be a valid measure of smoking cessation. According to Lichtenstein et al (1996), proactive telephone counseling caused a significant decrease in smoking. Those results were also supported by Stead, Perrera and Lancaster (2009), who found that both reactive and proactive telephone counseling was responsible for increased rates of smoking cessation among individuals. The rationale behind telephone counseling and its efficacy in smoking cessation are difficult to explain: most probably, smokers perceive telephone support as both reliable and anonymous, and which gives them a sense of confidence in dealing with the problem of smoking. It is also possible that telephone lines provide that assistance which smokers really need in their long and troublesome way to cessation. Whatever the rationale, individual counseling, either personal or telephone, can benefit nurses who are willing to quit smoking. Unfortunately, individual counseling is always associated with additional costs (Lichtenstein et al, 1996). New technologies provide the flexibility and communication opportunities required to reduce smoking among nurses. Yet, they also add to the burden of financial and technical expenses on hospitals. This is why individual counseling can give place to group counseling strategies. Group counseling is believed to be a better alternative to individual smoking cessation counseling. The current state of literature suggests that individual counseling alone cannot increase smoking cessation rates (Stead & Lancaster, 2009). Unfortunately, evaluating the benefits and outcomes of group counseling interventions is not possible, due to the heterogeneity of subjects involved in study samples (Stead & Lancaster, 2009). Moreover, group counseling is by itself not without controversy, since groups demonstrate limited reach to smoking populations and are characterized by low participation rates (Stead & Lancaster, 2009). Group counseling requires a double effort from nurses: on the one hand, they need motivation to quit smoking; on the other hand, they also need additional motivation, time, and desire to spend time on group meetings (Stead & Lancaster, 2009). However, the more nurses are willing to quit smoking, the more they will motivate others to engage in group counseling sessions. Coupled with nicotine-replacement therapy and cognitive-behavioral approaches, group counseling can become a good measure of smoking cessation among nurses. How effective nicotine replacement is for smoking cessation remains an object of professional debate. Since the beginning of the 1990s, clinical researchers studied and estimated the effectiveness of nicotine-replacement therapies in various population groups. Tang, Law and Wald (1994) were among the first to investigate the relationship between nicotine replacement and smoking cessation and discovered that both patch and gum were remarkably effective in supporting smokers, who were willing to quit. Today, the importance of nicotine-replacement solutions is widely established. Moreover, according to Silagy et al (2007), nicotine-replacement therapy enhances the quality of other interventions, like counseling. Whether it is better to use one or several nicotine-replacement instruments researchers were not able to define (Silgary et al, 2007). It is clear that all types of nicotine-replacement therapy without any exception are associated with high rates of relapse in the first three months of use (Silgary et al, 2007). Therefore, there is always the need for using other, additional methods of smoking cessation, either to prolong the effects of nicotine-replacement approaches or make them long-term (Silgary et al, 2007). This is probably why clinicians often apply to cognitive-behavioral therapy, to enhance smoking cessation outcomes. Many smokers have difficulty with quitting, mainly due to the long-term commitment to cigarettes and the lack of motivation. Both aspects can be readily addressed with the help of CBT. CBT is particularly effective in smokers with related complexities and dependencies, for example, depression (Brown et al, 2001). Brown et al (2001) found that CBT provided specific benefits for individuals with the history of depression and, consequentially, reduced the incidence of heavy smoking among them. Again, when it comes to motivation, monetary rewards can present a good alternative to other methods of smoking cessation. The inclusion of monetary rewards in the proposed facility-based program for nurses is justified by the fact that monetary incentives are extremely efficient against workplace smoking. Volpp et al (2006) found that “modest financial incentives are associated with significantly higher rates of smoking cessation program enrollment and completion and short-term quit rates” (p.12). These financial incentives can come in several different forms, including no-smoking contests, no-smoking lotteries, and even contracts (Stachnik & Stoffelmayr, 1983). The main question is why all proposed instruments are used integrally in one program, instead of being used separately. The answer is simple: none of the proposed instruments is effective, when not supported by other smoking cessation interventions. Group counseling often lacks involvement and displays low participation rates, and should be used in combination with individual therapies (Stead & Lancaster, 2009). Monetary rewards produce only short-term gains (Volpp et al, 2006), whereas nicotine-replacement therapies, when used alone, cause high relapse rates (Silagy et al, 2007). Cognitive-behavioral therapy does not address smoking as such but helps individuals to deal with other, related health complications (Brown et al, 2001). All these methods are equally effective, when used as part of complex interventions and strategies. Based on the current research, the proposed strategy will support nurses in their way to life free of smoking. What is needed is to estimate the costs and gains of the proposed program and develop a system of monetary benefits to be provided to nurses who quit smoking. Conclusion Smoking is a serious problem among nurses. Much has been written and said about the role and importance of smoking cessation programs in clinical settings. Individual counseling can benefit nurses who are willing to quit smoking. The importance of nicotine-replacement solutions has been widely established. Group counseling enhances the quality of smoking cessation outcomes. Monetary rewards can present a good alternative to other methods of smoking cessation. When used together, all these methods have the potential to raise the rates of smoking cessation among nurses. What is needed is to estimate the costs and gains of the proposed program and develop a system of monetary benefits to be provided to nurses who quit smoking. References Brown, R.A., Kahler, C.W., Niaura, R., Abrams, D.B., Sales, S.D., Ramsey, S.E., Goldstein, M.G. et al. (2001). Cognitive-behavioral treatment for depression in smoking cessation. Journal of Consulting in Clinical Psychology, 69(3), 471-480. Lancaster, T. & Stead, L.F. (2008). Individual behavioral counseling for smoking cessation. The Cochrane Library, 4, 1-50. Lichtenstein, E., Glasgow, R.E., Lando, H.A., Ossip-Klein, D.J. & Boles, S.M. (1996). Telephone counseling for smoking cessation: Rationales and meta-analytic review of evidence. Health Education Research, 11(2), 243-257. Silagy, C., Lancaster, T., Stead, L., Mant, D. & Fowler, G. (2007). Nicotine replacement therapy for smoking cessation. The Cochrane Library, 3, 1-109. Stachnik, T. & Stoffelmayr, B. (1983). Worksite smoking cessation programs: A potential for national impact. Public Health Briefs, 73, 1395-1396. Stead, L.F. & Lancaster, T. (2009). Group behavior therapy program for smoking cessation. The Cochrane Library, 2, 1-78. Stead, L.F., Perera, R. & Lancaster, T. (2009). Telephone counseling for smoking cessation. The Cochrane Library, 3, 1-95. Tagliacozzo, R. & Vaughn, S. (1982). Stress and smoking in hospital nurses. American Journal of Public Health, 72, 441-448. Tang, J.L., Law, M. & Wald, N. (1994). How effective is nicotine replacement therapy in helping people to stop smoking? BMJ, 308(21), 627-632. Volpp, K.G., Levy, A.G., Asch, .A., Berlin, J.A., Murphy, J.J., Gomez, A., Sox, H., Zhu, J. & Lerman, C. (2006). A randomized controlled trial of financial incentives for smoking cessation. Cancer Epidemiology and Biomarkers, 15, 12-18. Read More